The bone in your lower leg is called the tibia. For amateur and professional athletes, overuse injury or repetitive stress to the tibia may cause micro-tears in the bone and surrounding muscle. The resulting medical condition, medial tibial stress syndrome (MTSS), is a common complaint in the world of sports medicine. In colloquial language, people refer to this painful syndrome as "shin splints." Any physical activity may cause shin splints, but MTSS is especially likely to develop after you intensify your training routine or increase your activity too quickly. If you don't give yourself adequate time to recover and heal, it’s easy to overwork your tendons, muscles, and bones.
What Causes Shin Splints?
Although the exact cause of shin splints remains unknown, there are several dominant theories. Some researchers believe that the pain is caused by inflammation of the muscular attachment along the posterior medial tibia. Others argue that the pain signals inflammation of the periosteum, a layer of connective tissue that surrounds bone. Some attribute MTSS to the slow formation of new bone, as compared to the resorption of old bone, in the tibial cortex. No matter the cause, people with MTSS develop microtears in muscle and bone tissue. These microtears cause pain along the posteromedial tibial border, where the shinbone and muscle connect, for a length of at least five consecutive centimeters.
Risk Factors
Certain factors make you more likely to develop shin splints:
Gender. Females are more likely to develop MTSS than males.
Medical history. If you have had shin splints before, that will make you more likely to experience them in the future.
High body mass index (BMI). People with a higher body mass are predisposed to MTSS.
Foot mechanics. An improper gate, caused by pronation of the foot, flat feet, or an unusually high arch, may contribute to shin splints.
Uneven stride. A larger than usual range of hip motion, malalignment of the lower limbs, or a leg length discrepancy can all impact your stride, turning normal movement into high-impact activity.
Calf girth and tightness. People with lower lean calf girth measurements or tightness in their calf muscles are more likely to develop shin splints.
Sudden changes in activity level. Military recruits often suffer the pain of shin splints as they adjust to the rigors of basic training. Any sudden increase in the intensity or duration of your exercise routine can cause MTSS to develop.
Symptoms
The symptoms of shin splints are usually mild. They may include soreness or pain along the front of your lower leg, near the inner side of the shinbone. You’ll probably also experience inflammation and swelling in the lower leg. At the beginning of MTSS, it's common to feel pain only at the beginning of a workout. After warming up, the discomfort may subside. As shin splints worsen, you may feel worsening pain throughout your workout and even at rest.
If you continue exercising with existing microtears in your bone and muscle, you may encounter more serious symptoms. For example, the small tears in your bone can develop into stress fractures that cause long-term damage. Women are at an increased risk (1.5-3.5x) of having MTSS progress into stress fractures. (Galbraith 128) Doctors often perform an X-ray or a bone scan, in addition to a physical exam, when they diagnose MTSS. These diagnostic tests enable a doctor to determine the extent of the damage to your bones.
Treatments
In Clinics in Sports Medicine, doctors Robert P. Wilder and Shikha Sethi outline the best treatments for shin splints:
Reduced training. Rest is necessary, and it allows the muscles and bones time to repair themselves. During the break from running, you should focus on cross-training to build strength in other areas of the body. Next, slowly work running back into your routine, building gradually to increase the frequency or intensity of exercise. Always warm up properly, and avoid running on hills or uneven, hard surfaces.
Ice. Cooling the leg with an ice pack helps to reduce pain and inflammation.
Proper footwear. Some running shoes prevent improper pronation. Insoles and orthotics can be used with athletic shoes to correct a leg length discrepancy.
Compression therapy. Compression socks work to provide symptomatic relief for pain and inflammation.
Medication. Non-steroidal anti-inflammatories (NSAIDs), such as over-the-counter ibuprofen or naproxen sodium, can reduce pain and inflammation.
Physical therapy. A physical therapist can recommend a strengthening and flexibility program to help you correct muscle imbalances and develop a more even stride.
Operative treatment. Surgery may be considered to eliminate chronic, severe pain that does not respond to other treatments.
How Do Compression Socks Help?
Compression socks work to reduce the leg pain from shin splints in several ways. First of all, compression therapy stops your leg from swelling, reducing your inflammation both during and after a workout. Without compression socks, water weight in the lower legs may cause a runner to misstep or experience poor running form. By preventing swelling, compression socks help your legs to function well even during endurance exercise. Studies confirm that there are positive effects on running economy with the use of compression gear. (Engel Abstract) A more efficient stride causes less damage to muscles and bones, preventing microtears from forming.
As you work out, your body releases enzymes like lactic acid and creatine kinase. A large amount of creatine kinase can signify a muscle injury. Too much lactic acid in your bloodstream after a prolonged workout may cause pain, as your body is unable to metabolize the enzyme. With graduated compression socks, your leg veins get an extra boost. Upward pressure helps clear these chemicals out of your lower legs. By ridding your bloodstream of waste fluids, compression socks serve to promote faster recovery.
Lastly, compression therapy improves your cardiovascular health. Compression socks, like our most popular 15-25 mmHg Companions, ensure that your leg muscles receive freshly oxygenated blood—and that deoxygenated blood flows back to your heart for processing as efficiently as possible. The use of compression socks can prevent common vascular conditions. Proper cardiovascular functioning is crucial to healing damaged muscles and bones.
Outlook
Shin splints are extremely common. Although the symptoms may seem minor, without adequate treatment, the syndrome may delay or prohibit athletic training. Continued overuse may cause more serious complications, including tibial fractures. Prevention, through the use of gradual training increases, adequate rest, compression socks, proper footwear, and anti-inflammatory techniques (ice and medication), can help athletes stay active.
For a person who has already developed MTSS, rest becomes critical. Running with existing shin splints may cause severe pain and additional damage to your muscles and bones. While you heal, use ice, NSAIDs, and compression therapy to reduce inflammation and pain.
Sources:
Burne, S G et al. “Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study.” British journal of sports medicine vol. 38, iss. 4, 2004, pp. 441-445. https://doi.org/10.1136/bjsm.2002.004499.
Engel F.A., Holmberg H.C., Sperlich B. "Is There Evidence that Runners can Benefit from Wearing Compression Clothing?" Sports Med, vol. 46, iss. 12, 2016, pp. 939-952, https://www.researchgate.net/publication/301581402_Is_There_Evidence_that_Runners_can_Benefit_from_Wearing_Compression_Clothing.
Galbraith, R. M., and Mark E. Lavallee. "Medial tibial stress syndrome: conservative treatment options." Curr Rev Musculoskelet Med vol. 2, iss. 3, 2009, pp. 127–133. https://doi.org/10.1007/s12178-009-9055-6.
Mayo Clinic. (2019). Shin splints. https://www.mayoclinic.org/diseases-conditions/shin-splints/symptoms-causes/syc-20354105
Moen, Maarten H et al. “Medial tibial stress syndrome: a critical review.” Sports medicine (Auckland, N.Z.) vol. 39, iss. 7, 2009, pp. 523-546. https://doi.org/10.2165/00007256-200939070-00002
Wilder, Robert P, and Shikha Sethi. “Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.” Clinics in sports medicine vol. 23, iss. 1, 2004, pp. 55-81, https://doi.org/10.1016/S0278-5919(03)00085-1
Yates, Ben, and Shaun White. “The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.” The American journal of sports medicine vol. 32, iss. 3, 2004, pp. 772-80. https://doi.org/10.1177/0095399703258776